A poliovirus and SARS-CoV-2 are at a bar, looking over potential victims.
Polio starts bragging. “Hey, new guy. Ever hear the expression, ‘mess you up like polio?’”
New guy: “Hold my beer.”
What? Too soon?
In the late 1980s, we began seeing a rare form of a skin lesion and a particularly ugly and rare pneumonia start springing up in Philadelphia and San Francisco; young men were literally dying in the streets. A new virus, eventually named the Human Immunodeficiency Virus (HIV), and a new disease – Acquired Immune Deficiency Syndrome (AIDS) – were identified, a host of conditions rolled into one deadly, untreatable package.
Pneumocystis pneumonia permanently scarring the lungs, sarcoma, uncontrollable nausea and diarrhea, GI ailments of unusual severity, and more were common afflictions. For the first year or two, we had no idea of how it was transmitted; imaginations ran wild and conspiracy theories abounded. Rich, poor, even the famous and beloved, were taken from us. People became afraid of one another. The promiscuous 70s and 80s came to a screeching halt.
But the specialty of infectious disease gained special prominence, and our knowledge of the human immune system exploded.
Sounding familiar? We’ve been here before.
My first nursing position was in the ICU of a quaternary medical center in Phoenix, Arizona, in 1991. Some of my coworkers refused to accept an AIDS patient. How much of that was fear of infection, and how much was homophobia? In retrospect, it is a tough call. With youthful naiveté and the conviction that my Oath would protect me, I volunteered to take these patients. The level of my foolhardiness is amplified by today’s standards; there was no such thing as PPE, except for some latex gloves (which we all thought horribly inconvenient) and gowns to keep from messing up your scrubs with poop.
My most memorable patient was John. He had been a professor at a community college close to my home. He lost his job when he “came out,” and soon after was diagnosed with AIDS. When he came to me, he was in full-blown pneumocystis pneumonia, intubated and on a ventilator at settings so high, one cannot imagine how desperate for air he had been.
I was determined that John was getting off the ventilator. He did not want to be sedated. He put up with me suctioning him, frequently and deep. We bonded. By writing in a notebook, he told me his story, the job loss, abandonment by friends, and how he had a few things to do before he cashed in his chips.
The day came when John left the ICU and was headed for our transitional care unit. He made me swear that when he returned – he knew he was not long for this world – I would be his nurse. And he wanted me to swear I would not let him be put on a ventilator again. When he returned, it would be time to call it quits. It was a bittersweet moment. I made that promise. What we now accept as the norm – a patient’s right to self-determination – was new, and not universally embraced. The doctor knew best, end of story.
I don’t recall how long it was before John returned. He asked to come to my unit. I was on duty. He took my hand and demanded I keep my promise. He was gasping for breath, but had been successful thus far in fending off attempts to intubate him. At the door was the medical director, ET tube and curved blade in hand. I stood solidly in the doorway.
“You need to move, that man will die if he’s not on a ventilator,” he said.
“Talk to your patient first, doctor,” I replied.
“Talk to your patient. He does not want to be intubated. He told me that the last time he was here, and I made a promise to keep it from happening.”
“Talk to your patient, please, doctor.”
He did. A few moments later, he came out, looking more than a little defeated. He swore to beat disease, not bend to its will without a fight. And I get that. It’s what I admired about him.
What I came away with is that my professors were right. Nursing is a different profession in one key way: we don’t so much treat illness as treat the patient’s responses to illness. Perhaps more clearly stated: regardless of the outcome – life or death – there is the potential for victory.
Even though this new enemy is viler than anything seen in a century or more, this thought comes though: we are better than this thing, we are tougher than this thing. We’ve been here before, and lived to see another day, and are better for it.